Case Manager (Non-RN) jobs in Santa Barbara, CA

Non-profit healthcare network is looking for a registered nurse case manager to join their team on a contract basis! Opportunity to gain experience with Medi-Cal and work REMOTELY in a fast-paced environment.

REQUIREMENTS:

• CA RN license
• Flexible to work a 6-month contract
• At least 6 months of case management experience

WHAT'S IN IT FOR YOU:

• Remote opportunity
• Gain experience with a leading healthcare organization

Description:

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse who is assigned to one of several Health Services’ operational units. These units include, but are not limited to, the Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. This position reports to the Program’s Manager or their designee of the assigned unit. Depending on unit assignment, the HPNC may perform utilization management activities, which may include telephonic or onsite clinical review; case or disease management, care coordination or transition, or population health activities; or a combination of all. The HPNC may be assigned to sub-specialized programs within an operational unit, such as Mental/Behavioral Health services. These sub-specialized programs require the RN to perform UM or CM activities for a specific member population. Bilingual in Spanish may be required for positions that primarily requires interaction with members

Responsibilities:

• Comply with HIPAA, Privacy, and Confidentiality laws and regulations
• Adhere to Health Plan, Medical Management and Health Services policies and procedures
• Be abreast on clinical knowledge related to disease processes
• Effectively communicate, verbally and in writing, with providers, members, vendors, and other health care providers and in a timely, respectful and professional manner
• Function as a collaborative member of Medical Management/Health Services’ multi-disciplinary medical management team
• Identify and report quality of care concerns to management and as directed, to appropriate department for follow up
• Support and collaborate with the management, medical management and health services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities
• As required, actively participate in the implementation, assessment, and evaluation of quality improvement activities as it relates to job duties
• Adhere to mandated reporting requirements appropriate to professional licensing requirements
• Comply with regulatory standards of governing agency
• Be positive, flexible, and open toward operational changes
• Attend and actively participate in department meetings
• Support and work collaboratively with the Medical Management and Health Services management team in the implementation and management of UM/CM/DM/PH activities
• Actively participate in the development, implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member’s quality of care
• Keep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practice

Skills:

Case Management, Medi-Cal, Medicare, RN, health plan

Experience Level:

Entry Level

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